Electrical status epilepticus during sleep. Continuous spikes and waves during sleep

ABSTRACT Maria Peltola Electrical status epilepticus during sleep – Continuous spikes and waves during sleep Department of Clinical Neurophysiology, University of Turku Department of Clinical Neurophysiology and Department of Pediatric Neurology, Children’s Hospital, Helsinki University Central Hospital Annales Universitatis Turkuensis, Medica-Odontologica, Turku, Finland, 2014 Background: Electrical status epilepticus during sleep (ESES) is an EEG phenomenon of frequent spikes and waves occurring in slow sleep. ESES relates to cognitive deterioration in heterogeneous childhood epilepsies. Validated methods to quantitate ESES are missing. The clinical syndrome, called epileptic encephalopathy with continuous spikes and waves during sleep (CSWS) is pharmacoresistant in half of the patients. Limited data exists on surgical treatment of CSWS. Aims and methods: The effects of surgical treatment were studied by investigating electroclinical outcomes in 13 operated patients (nine callosotomies, four resections) with pharmacoresistant CSWS and cognitive decline. Secondly, an objective paradigm was searched for assessing ESES by the semiautomatic quantification of spike index (SI) and measuring spike strength from EEG. Results: Postoperatively, cognitive deterioration was stopped in 12 (92%) patients. Three out of four patients became seizure-free after resective surgery. Callosotomy resulted in greater than 90% reduction of atypical absences in six out of eight patients. The preoperative propagation of ESES from one hemisphere to the other was associated with a good response. Semiautomatic quantification of SI was a robust method when the maximal interspike interval of three seconds was used to determine the “continuous” discharge in ten EEGs. SI of the first hour of sleep appeared representative of the whole night SI. Furthermore, the spikes’ root mean square was found to be a stable measure of spike strength when spatially integrated over multiple electrodes during steady NREM sleep. Conclusions: Patients with pharmacoresistant CSWS, based on structural etiology, may benefit from resective surgery or corpus callosotomy regarding both seizure outcome and cognitive prognosis. The semiautomated SI quantification, with proper userdefined settings and the new spatially integrated measure of spike strength, are robust and promising tools for quantifying ESES. Keywords: Electrical status epilepticus during sleep, ESES, continuous spikes and waves during sleep, CSWS, epilepsy surgery, spike index, spike strength, RMS TIIVISTELMÄ Maria Peltola Unenaikainen sähköinen status epilepticus Kliininen neurofysiologia, Turun yliopisto Kliininen neurofysiologia ja lastenneurologia, Lasten ja nuorten sairaala, Helsingin yliopistollinen keskussairaala Annales Universitatis Turkuensis, Medica-Odontologica, Turku, Suomi, 2014 Tausta: Sähköinen status epilepticus unessa (ESES) on aivosähkökäyrä (EEG)-ilmiö, jossa hidasaaltounen aikana esiintyy tiheä piikkihidasaaltopurkaus. ESES:n kvantifioimiseen ei ole olemassa validoituja menetelmiä. ESES on liitetty kognitiivisen tason laskuun ja tällöin puhutaan CSWS (continuous spikes and waves during sleep) - oireyhtymästä. CSWS ei vastaa lääkehoitoon puolella potilaista ja sen epilepsiakirurgisesta hoidosta on olemassa vain vähän tietoa. Tavoitteet ja menetelmät: Selvitimme retrospektiivisesti epilepsiakirurgian vaikusta elektrokliinisiin löydöksiin 13:lla lääkeresistenttiä CSWS-oireyhtymää sairastavalla lapsella, joilla oli rakenteellinen aivojen poikkeavuus. Toinen tavoite oli löytää objektiivinen puoliautomaattinen tapa mitata purkauksen määrää ja piikkien voimakkuutta EEG:stä. Tulokset: Kognitiivisen tason jatkuva heikentyminen loppui 12 (92 %) potilaalla leikkauksen jälkeen. Kolme neljästä resektiopotilaasta tuli kohtauksettomaksi. Kallosotomian jälkeen kuudella kahdeksasta potilaasta päivittäiset kohtaukset vähenivät yli 90 %:lla. Purkauksen leviäminen leikkausta edeltävästi vain yhdestä hemisfääristä toiseen liittyi hyvään leikkaushoitovasteeseen. Piikki-indeksi, jossa käytetään jatkuvan purkauksen määritelmänä maksimissaan kolmea sekuntia piikkien välillä, osoittautui luotettavaksi menetelmäksi ESES:n kvantifioimiseen. Useammasta elektrodista integroitu piikkien neliöllinen keskiarvo oli piikin voimakkuuden vakaa mitta häiriintymättömässä NREM-unessa. Päätelmät: Lääkehoidolle vastaamatonta CSWS:ää sairastavat potilaat, joilla on rakenteellinen aivopoikkeavuus ja yhdensuuntainen purkauksen leviämismalli, näyttävät kohtausten vähenemisen lisäksi hyötyvän epilepsiakirurgiasta kognitiivisesti. Puoliautomaattinen piikki-indeksin kvantifiointi sopivilla käyttäjäasetuksilla ja uusi spatiaalisesti integroitu piikin voimakkuuden mittari ovat stabiileja ja lupaavia ESES:n kvantitatiivisia mittareita. Avainsanat: Unenaikainen sähköinen status epilepticus, ESES, CSWS, epilepsiakirurgia, piikki-indeksi, piikin voimakkuus, neliöllinen keskiarvo

Sawtooth waves during REM sleep after administration of haloperidol combined with total sleep deprivation in healthy young subjects

We sought to examine the possible participation of dopaminergic receptors in the phasic events that occur during rapid eye movement (REM) sleep, known as sawtooth waves (STW). These phasic phenomena of REM sleep exhibit a unique morphology and, although they represent a characteristic feature of REM sleep, little is known about the mechanisms which generate them and which are apparently different from rapid eye movements. STW behavior was studied in 10 male volunteers aged 20 to 35 years, who were submitted to polysomnographic monitoring (PSG). On the adaptation night they were submitted to the first PSG and on the second night, to the basal PSG. On the third night the volunteers received placebo or haloperidol and spent the whole night awake. On the fourth night they were submitted to the third PSG. After a 15-day rest period, the volunteers returned to the sleep laboratory and, according to a double-blind crossover randomized design, received haloperidol or placebo and spent the whole night awake, after which they were submitted to the fourth PSG. The volunteers who were given haloperidol combined with sleep deprivation exhibited an elevation of the duration and density of the STW, without significant alterations of the other REM sleep phasic phenomena such as rapid eye movement. These findings suggest that sawtooth waves must have their own generating mechanisms and that the dopaminergic receptors must exert a modulating role since REM sleep deprivation, as well as administration of neuroleptics, produces supersensitivity of dopaminergic receptors.

Spin-electromagnetic waves spectra in multiferroic heterostructures

This work devotes to the theoretical investigations of spin-electromagnetic waves (SEW) propagating in a thin-film multiferroic structures that were composed of a slot-line and structures with several ferrite films. In contrast to earlier works, the spin-electromagnetic waves in the investigated structures are originated from two different electrodynamics coupling. The first one is coupling of the electromagnetic wave localized mainly in the slot-line with the spin wave excited mostly in the ferrite film. The second one is coupling of two spin waves in the different ferrite films separated by a thin ferroelectric film. For theoretical analysis of SEWs propagation in such kind of structures theories of their eigen-wave spectra were developed. Spectra of SEW in the investigated structures were calculated and analyzed. The range of electric and magnetic tunability of dispersion characteristic were investigated. Spectra of SEW in the investigated multiferroic structures are used for investigation of transfer function of periodic structures.

Culture alternative medium for the growth of extreme halophilic bacteria in fish products

Halotolerant or halophilic (Archaeabacteria) microorganisms can be found in salted and ripening fish products that are not affected by salt. They can be moderate or extremely halophilic bacteria. The extremely halophilic bacteria require between 15-30% of NaCl for growth. The extremely halophilic archaeobacteria may be selectively isolated in different media. The aim of this work was to determine the effectiveness of the Salt-Agar-Milk medium, a medium modified in our laboratory through the addition of MgSO4 and KCl - named SAMm, and its effect on the bacterial growth by means of comparison with other media, with and without milk, determining time of incubation and counting. Two samples of salted fish from local fish salting factories and two laboratory strains were used. The factory samples were matured anchovy and anchovy fillets in oil, and the laboratory strains were: Haloarcula spp. (proteolytic) and Halococcus spp. (non-proteolytic). The following media were alternatively used for the isolation of extremely halophilic bacteria: IRAM; Formulation of Gibbons and collaborators, Cod Milk agar, and SAMm. IRAM and Gibbons were also used enriched with milk. In the SAMm medium, there were obtained count values similar or higher than the ones of the traditional media; besides the simplicity of its elaboration, the possibility to obtain positive results two or three days earlier also added to its benefit. Consequently, it can be considered an alternative to the media traditionally used for the studied halophilic bacteria.

Extreme Observables and Optimal Measurements in Quantum Theory

Optimization of quantum measurement processes has a pivotal role in carrying out better, more accurate or less disrupting, measurements and experiments on a quantum system. Especially, convex optimization, i.e., identifying the extreme points of the convex sets and subsets of quantum measuring devices plays an important part in quantum optimization since the typical figures of merit for measuring processes are affine functionals. In this thesis, we discuss results determining the extreme quantum devices and their relevance, e.g., in quantum-compatibility-related questions. Especially, we see that a compatible device pair where one device is extreme can be joined into a single apparatus essentially in a unique way. Moreover, we show that the question whether a pair of quantum observables can be measured jointly can often be formulated in a weaker form when some of the observables involved are extreme. Another major line of research treated in this thesis deals with convex analysis of special restricted quantum device sets, covariance structures or, in particular, generalized imprimitivity systems. Some results on the structure ofcovariant observables and instruments are listed as well as results identifying the extreme points of covariance structures in quantum theory. As a special case study, not published anywhere before, we study the structure of Euclidean-covariant localization observables for spin-0-particles. We also discuss the general form of Weyl-covariant phase-space instruments. Finally, certain optimality measures originating from convex geometry are introduced for quantum devices, namely, boundariness measuring how ‘close’ to the algebraic boundary of the device set a quantum apparatus is and the robustness of incompatibility quantifying the level of incompatibility for a quantum device pair by measuring the highest amount of noise the pair tolerates without becoming compatible. Boundariness is further associated to minimum-error discrimination of quantum devices, and robustness of incompatibility is shown to behave monotonically under certain compatibility-non-decreasing operations. Moreover, the value of robustness of incompatibility is given for a few special device pairs.

Static waves in corporate space : characterizing oscillating trading patterns in New York stock exchange

Various researches in the field of econophysics has shown that fluid flow have analogous phenomena in financial market behavior, the typical parallelism being delivered between energy in fluids and information on markets. However, the geometry of the manifold on which market dynamics act out their dynamics (corporate space) is not yet known. In this thesis, utilizing a Seven year time series of prices of stocks used to compute S&P500 index on the New York Stock Exchange, we have created local chart to the corporate space with the goal of finding standing waves and other soliton like patterns in the behavior of stock price deviations from the S&P500 index. By first calculating the correlation matrix of normalized stock price deviations from the S&P500 index, we have performed a local singular value decomposition over a set of four different time windows as guides to the nature of patterns that may emerge. I turns out that in almost all cases, each singular vector is essentially determined by relatively small set of companies with big positive or negative weights on that singular vector. Over particular time windows, sometimes these weights are strongly correlated with at least one industrial sector and certain sectors are more prone to fast dynamics whereas others have longer standing waves.

A Comparative Analysis of Community-Based Service Providers for "Extreme" Case ASD: Exploring Activity Program Options

The purpose of my research was to examine how community-based organizations in the Niagara region provide programs for children with Autism Spectrum Disorder (ASD), who are considered to represent “extreme” or “severe” cases. A qualitative, comparative case study was conducted that focused on three organizations who provide summer recreation and activity programs, in order to examine the issues these organizations face when determining program structure and staff training; and to understand what the threshold for physical activity is in this type of setting, and how the unique needs surrounding these “severe” cases are met while attending the program. Purposeful sampling was employed to select a supervisor and senior staff member from each organization to discuss the training process, program development and implementation, and the resources and strategies used within their organization’s community-based program. A confirming comparative analysis was comparative analysis of a parents survey with six mothers whose children are considered “severe” indicated that camp staffs’ expectations are unrealistic where as the parents and supervisors have more realistic expectations within the “real world” of camp. There is no definition of “severe” or “extreme” and therefore severity is dependent upon the context.

Challenging Indifference to Extreme Poverty: Considering Southern Perspectives on Global Citizenship and Change

Canadian universities are expanding opportunities for students to travel, study, volunteer and work abroad for academic credit, especially in regions of the global south often called “developing countries.” It is widely assumed that exposure to extreme poverty through shortterm placements overseas will make young Canadians and other Northerners into “global citizens” who would by definition be incapable of indifference to the lack of freedom that accompanies extreme poverty. This paper asks whether it is warranted for Northerners to attain a claim to global citizenship via this mechanism, especially in light of the burdens falling upon Southern organizations that host young people from Canada and elsewhere.

Conceptual blending and the mapping of the inner recesses of the mind in Virginia Woolf's The Waves

Cette étude offre une lecture de The Waves de Virginia Woolf en tant qu’une représentation fictive des “formes exactes de la pensée.” Elle établit le lien entre le récit de The Waves et l’expérience personnelle de l’auteur avec “les voix” qui hantaient son esprit, en raison de sa maladie maniaco-dépressive. La présente étude propose également une analyse du roman inspirée par la théorie de la “fusion conceptuelle:” cette approche narrative a pour but de (1) souligner “la fusion” de l’imagination, des émotions, et de la perception qui constitue l’essence du récit de The Waves, (2) mettre l’accent sur les “configurations mentales” subtilement développées par/entre les voix du récit, en vue de diminuer le semblant de la désorganisation et de l’éparpillement des pensées généré par la représentation de la conscience, (3) permettre au lecteur d’accéder à la configuration subjective et identitaire des différentes voix du récit en traçant l’éventail de leurs pensées “fusionnées.” L’argument de cette dissertation est subdivisé en trois chapitres: le premier chapitre emploie la théorie de la fusion conceptuelle afin de souligner les processus mentaux menant à la création de “moments de vision.” Il décrit la manière dont la fusion des pensées intérieures et de la perception dans les “moments de vision” pourrait servir de tremplin à la configuration subjective des voix du récit. La deuxième section interprète l’ensemble des voix du roman en tant qu’une “société de soi-mêmes.” À l’aide de la théorie de la fusion conceptuelle, elle met l’accent sur les formes de pensée entrelacées entre les différentes voix du récit, ce qui permet aux protagonistes de développer une identité interrelationnelle, placée au plein centre des différentes subjectivités. Le troisième chapitre trace les processus mentaux permettant aux différentes voix du roman de développer une forme de subjectivité cohérente et intégrée. Dans ce chapitre, l’idée de la fusion des différents aspects de l’identité proposée par Fauconnier et Turner est employée pour décrire l’intégration des éléments de la subjectivité des protagonistes en une seule configuration identitaire. D’ailleurs, ce chapitre propose une interprétation du triste suicide de Rhoda qui met en relief son inaptitude à intégrer les fragments de sa subjectivité en une identité cohérente et “fusionnée.”

Effets des changements climatiques sur la santé et la sécurité des travailleurs au Québec

Les impacts des changements climatiques sur la population sont nombreux et ont été relativement bien documentés, ce qui n’est pas le cas de ces impacts sur la santé et la sécurité des travailleurs. L’objectif de cette thèse est de documenter les effets négatifs des changements climatiques sur la santé et la sécurité des travailleurs dans une région d’un pays industrialisé à climat tempéré, comme le Québec. Pour y arriver, deux approches ont été utilisées : a) les dangers et les effets sanitaires ont été identifiés par une revue de la littérature validée par des experts nationaux et internationaux, et des priorités de recherche ont été établies à l’aide d’une méthode de consultation itérative, b) des modèles statistiques, utiles à l’estimation des impacts sanitaires des changements climatiques, ont été développés pour apprécier les associations entre la survenue de lésions professionnelles et l’exposition des travailleurs aux chaleurs estivales et à l’ozone troposphérique, deux problématiques préoccupantes pour le Québec. Le bilan des connaissances a mis en évidence cinq catégories de dangers pouvant affecter directement ou indirectement la santé et la sécurité des travailleurs au Québec (vagues de chaleur, polluants de l’air, rayonnements ultraviolets, événements météorologiques extrêmes, maladies vectorielles transmissibles et zoonoses) et cinq conditions pouvant entraîner des modifications dans l’environnement de travail et pouvant ultimement affecter négativement la santé et la sécurité des travailleurs (changements dans les méthodes agricoles et d’élevage, altérations dans l’industrie de la pêche, perturbations de l’écosystème forestier, dégradation de l’environnement bâti et émergence de nouvelles industries vertes). Quant aux modélisations, elles suggèrent que les indemnisations quotidiennes pour des maladies liées à la chaleur et pour des accidents de travail augmentent avec les températures estivales, et que ces associations varient selon l’âge des travailleurs, le secteur industriel et la catégorie professionnelle (manuelle vs autre). Des associations positives statistiquement non significatives entre les indemnisations pour des atteintes respiratoires aiguës et les concentrations d’ozone troposphérique ont aussi été observées. Dans l’ensemble, cette thèse a permis de dégager douze pistes de recherche prioritaires pour le Québec se rapportant à l’acquisition de connaissances, à la surveillance épidémiologique et au développement de méthodes d’adaptation. Selon les résultats de cette recherche, les intervenants en santé au travail et les décideurs devraient déployer des efforts pour protéger la santé et la sécurité des travailleurs et mettre en place des actions préventives en vue des changements climatiques.